Although myocardial infarction is most often the manifestation of epicardial coronary artery disease, Chagas heart disease due to chronic Trypanasome Cruzi infection may present with a syndrome of chest pain and elevations in markers of cardiac myonecrosis. In the setting of an increasingly diverse global population and immigration of peoples from endemic areas of Trypanasome Cruzi, it is important to be aware of the myriad cardiac manifestations of Chagas disease.